ensure the safety of ephedrine-containing dietary
supplements and what further action should be
taken in this area.
Our ability to increase our understanding of the
role of herbal remedies in medicine is hampered by
deforestation, and the loss of knowledge held
about plant therapies by indigenous people as the
Amazon and other remote areas are developed.
Activity in biodiversity is being supported by the
NIH, the National Institute of Mental Health, the
National Science Foundation, and the US Agency
for International Development.^2 Both the tradi-
tional medical community and the adherents of
alternative therapy have called for increased
research into this area.
Manual Healing MethodsThe healer’s touch has been considered a therapeu-
tic instrument for the entire history of medicine,
dating back to instructions by Hippocrates about
therapeutic massage. Ancient Chinese medicine
has strong roots in this system, and several areas of
alternative medicine are associated with manual
healing methods. The major fields of manual heal-
ing include (1) methods that use physical touch,
manipulation, and pressure—chiropractic and
osteopathic manipulation are primary examples;
(2) therapies that use an “energy field” that can
influence healing; and (3) mixed interventions that
use both physical touch and energy field therapy.
OsteopathyOsteopathic physicians derive their theories from
the work of Andrew Taylor Still (1828–1917), a
physician’s son who was trained as an apprentice to
his father. After the Civil War, he began an empir-
ical study of healing by manipulating bones and
soft tissues to allow the free circulation of blood
and lymph, and to restore the nervous system to
what he considered a more normal function.
Known as the “lightning bone-setter,” he disdained
the common practices of physicians in the last cen-
tury such as venesection, emesis, and sedation with
narcotics, preferring to use manipulation to
enhance the body’s innate ability to heal itself.
Instead of using drugs, he believed that the solu-
tion to illness lay in treating the underlying condi-
tion, allowing the body’s natural forces to return
the patient to health. He proposed that much more
than headache and back pain could be treated with
manipulation, and set forth a regimen of therapy
that included treatment for serious conditions such
as pneumonia, dysentery, and typhoid fever.
The first school of osteopathy was opened in
Missouri in 1892, teaching a variety of methods:
manipulation of soft tissue, isometric and isotonic
muscle techniques, manipulation with varying
“velocity,” the use of the percussion hammer to
strike the body to alleviate “restrictions” in the
joints and muscles that allowed internal processes
to function normally, and other unorthodox thera-
pies. Since that time, osteopathic education and its
practitioners have become nearly indistinguishable
from their allopathic cousins, with the exception of
manipulation techniques that continue to be inte-
gral parts of osteopathic diagnostic and treatment
modalities. Modern osteopathic physicians are con-
sidered to be in the mainstream of medical practice,
with rigorous standards for education and specialty
training. Osteopathic physicians commonly com-
plete allopathic postgraduate specialty training, and
are licensed to practice the full scope of medicine in
all states, without restrictions. Some advocates of
alternative medicine criticize modern osteopaths
for abandoning the original scope and breadth of
manipulation therapy.Chiropractic
As with many systems in alternative medicine, chi-
ropractic holds that the innate ability of the body to
heal itself can be optimized by achieving a “bal-
ance”; that proper function of the nervous system
is key to this homeostasis; that “subluxations” of
the spine and misalignment of joints impinge on
nerves, causing imbalance in internal systems; and
that manual release of these structural and func-
tional joint pathologies can heal a number of con-
ditions, and prevent illness as well.^12
The theories behind chiropractic have been
widely criticized. A 1968 study by the US Depart-
ment of Health, Education, and Welfare concluded
that chiropractic schools did not prepare students
to adequately diagnose and treat patients, and rec-
ommended that their services not be covered
under Medicare.2,12 In 1972, Congress added
Medicare benefits for “manual manipulation of theAppendix II 193